CHAPTER 3 and taping the neck Techniques for testing

[Pages:41]CHAPTER

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Techniques for testing and taping the neck

Sternocleidomastoid (SCM) Scalenes Splenius capitis Splenius cervicis Levator scapula Upper trapezius

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3 ? Techniques for testing and taping the neck

ANATOMY Sternocleidomastoid (SCM)

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Sternocleidomastoid (SCM)

Origin:

Manubrium of the sternum and medial ?/ of the clavicle

Insertion:

Mastoid process of the temporal bone and the lateral ? of the superior nuchal line of the occiput

Nerve supply: Accessory nerve (cranial nerve XI). Ventral rami of C2, C3

Function:

Flexes the lower cervical spine and extends the upper cervical spine. Laterally flexes and contralaterally rotates the head and neck. Elevates the sternum at the clavicle

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LENGTH, STRENGTH AND KINESIO TAPE: MUSCLE TESTING AND TAPING INTERVENTIONS

MUSCLE TESTING Sternocleidomastoid (SCM)

STRENGTH BIAS TESTING

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Client position

The client is lying supine with the head in full rotation to the contralateral side.

Instruction to client

The client is instructed to maintain the rotated head position whilst lifting the head off the bed.

Examiner position and notes

The examiner sits at the top of the bed with the testing hand positioned over the head above the level of the ear and the supporting hand under the occiput in case the client is unable to hold the position at the start or fatigues. The examiner should note if the client is attempting to rotate the head back to neutral as a compensatory strategy.

Resistance

The examiner places the hypothenar eminence above the ear and applies a force from one ear to the other in the direction down towards the bed. Resistance using the hypothenar eminence reminds the examiner to be careful, controlled and less aggressive with the testing of the neck. Practitioners are encouraged to use the hypothenar eminence to first learn the test in order to avoid accidental or excessive pressure on the ears and/or neck; practitioners familiar with aggressive handling during treatments are also less likely to apply excessive force when using the less familiar hypothenar eminence during testing. Naturally, once the examiner is comfortable with the appropriate resistance to apply, the hand position can be modified.

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3 ? Techniques for testing and taping the neck

MUSCLE TESTING Sternocleidomastoid (SCM)

LENGTH BIAS TESTING

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Client position

The client is seated with neutral lordosis and with the feet supported.

Instruction to client

The client is instructed to relax the neck in order for the examiner to move the neck into extension, lateral flexion and rotation to the side being tested.

Examiner position and notes

The examiner stands behind and to the side of the muscle being tested on the client. The examiner's outside forearm rests over the lateral aspect of the client's shoulder and stabilises it whilst the examiner assesses for compensatory movements. The fingertips of this upper limb are positioned over the client's chin in order to direct movement. The other hand is placed on the occiput of the client to direct movement and assess for resistance at the end of range. Whilst stabilising the lateral shoulder, the client is first taken into cervical extension, then lateral flexion away and then rotation to the same side. The SCM and scalenes have very similar movement functions and so the determination to tape one muscle in preference to the other is identified by the bias with which each muscle is taken into the lengthened position. The SCM being more anteriorly placed is `wound' up first by taking the neck into extension. As the primary movement vector for the SCM is lower cervical spine flexion and upper cervical extension, the process of first lengthening the muscle by taking the lower cervical spine into extension implicates SCM length restrictions over scalenes if the tension is earlier in the movement. Palpation of the muscles also helps to prioritise an intervention of SCM or scalenes.

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LENGTH, STRENGTH AND KINESIO TAPE: MUSCLE TESTING AND TAPING INTERVENTIONS

KINESIO TAPING Sternocleidomastoid (SCM)

STRENGTH TAPING

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Client position

The client is seated with the neck held in extension and lateral flexion away from the side being taped. Rotate the neck so that the chin is facing up to the ceiling.

Measurement of tape

Measure a length of tape from the mastoid process to the sternum. Cut this tape down the centre into two strips, each 2.5 cm-wide; the second strip can be applied to the other side or used for a subsequent application. Cut the 2.5 cm-wide strip in two again and round out the edges of both strips of tape. Alternatively, cut the mastoid anchor into a crescent shape and cut the remaining tape into a Y-strip. Finally, round both anchors at the end of the Y-strip.

Tape application

Sternal head: apply the starting anchor to the sternum with zero tension. Place the tissue in the lengthened position and apply the base of the tape over the muscle with 15?25% tension towards the mastoid process. Apply the final anchor on the mastoid with zero tension. Clavicular head: apply the starting anchor on the clavicle with zero tension. Place the tissue in the lengthened position and apply the base of the tape over the muscle with 15?25% tension towards the mastoid process. Apply the final anchor on the mastoid process with zero tension. Alternative Y application: apply the mastoid anchor to the mastoid process with zero tension. Place the tissue in the lengthened position and tear the backing of the tape so that each tail can be applied separately. Apply each tail down to the sternal and clavicular origins respectively with 25?35% tension. Apply each anchor over the sternum or clavicle with zero tension.

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3 ? Techniques for testing and taping the neck

STRENGTH TAPING

Additional notes

When applying a Y-strip it is more practical to start at the common anchor and apply the two tails on to the skin with the appropriate tension and the correct position rather than start at two anchors and attempt to come to a common point from different start positions, as this may in fact adversely affect the tension of the application.

The hairline may be a sensitive area or may require a special cut of the tape in order to tape higher

into the neck line. It is often more practical to start the tape at the hairline and apply the tape with the

appropriate tension to achieve results, rather than start in the reverse direction and find that the tape is

too long and have to trim the tape near hair. For the initial application, it can be more practical to apply a Y-strip to determine an appropriate length of tape. Once an ideal length of tape is confirmed, practitioners

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may start at the sternum for subsequent applications and use two separate I-strips.

Reassessment

Reassess your client for changes in strength, tonal changes, functional changes and symptoms.

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LENGTH, STRENGTH AND KINESIO TAPE: MUSCLE TESTING AND TAPING INTERVENTIONS

KINESIO TAPING Sternocleidomastoid (SCM)

LENGTH TAPING

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Client position

The client is seated with the neck held in extension and lateral flexion away from the side being taped. Rotate the neck so that the chin is facing up to the ceiling.

Measurement of tape

Measure a length of tape from the mastoid process to the sternum. Cut this tape down the centre into two strips, each 2.5 cm-wide; the second strip can be applied to the other side or used for a subsequent application. Cut the mastoid anchor into a crescent shape and cut the remaining tape into a Y-strip. Finally, round both anchors at the end of the Y-strip.

Tape application

Apply the mastoid anchor to the mastoid process with zero tension. Place the tissue in the lengthened position and tear the backing of the tape so that each tail can be applied separately. Run each tail down to the sternal and clavicular origins respectively with 15?25% tension. Apply each anchor over the sternum or clavicle with zero tension. Rub the tape to activate the glue.

Additional notes

As the neck is a sensitive area, tension towards the lower side of the spectrum is recommended.

Reassessment

Reassess your client for changes in length, strength, tonal changes, functional changes and symptoms.

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3 ? Techniques for testing and taping the neck

ANATOMY Scalenes

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Anterior scalene

Origin:

First rib at the scalene tubercle

Insertion:

Transverse process C3?6

Nerve supply:

Ventral rami of C4?6

Function:

Flexes, laterally flexes and contralaterally rotates the neck. Elevates the first rib when acting from above

Middle scalene

Origin:

First rib lateral to the tubercle of the first rib

Insertion:

Transverse process C2?7

Nerve supply:

Ventral rami C3?8

Function:

Laterally flexes and flexes the neck. Elevates the first rib when acting from above

Posterior scalene

Origin:

Second rib behind the tubercle for the serratus anterior

Insertion:

Transverse process C5?7

Nerve supply:

Ventral rami C6?8

Function:

Laterally flexes the neck. Elevates the second rib when acting from above

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